Individual
CHARLES SCOTT NEEDHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1841 E RIVERSIDE DR STE 102, ST GEORGE, UT 84790-7063
(435) 900-6001
(435) 900-6001
Mailing address
1841 E RIVERSIDE DR STE 102, ST GEORGE, UT 84790-7063
(435) 900-6001
(435) 900-6001
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
10916
MT
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
188161-1205
UT
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
25878
NV
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
M-12600
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000092896
BCBS PIN
MT
01
—
0151589
MDCD PIN
MT
01
—
122226100
MDCD PIN
WY
Enumeration date
07/25/2006
Last updated
09/25/2024
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